Group B Strep Explained

GBSE coverAfter a long Summer of writing, I am really happy to tell you that my latest AIMS book, Group B Strep Explained, is now rolling off the presses!  Already available to pre-order from AIMS website, the book costs £8 and has been written for women who need to make decisions about GBS screening and treatment, and for anyone who wants to better understand this area.  This is a complex topic in which the evidence and the issues are not clear-cut, and we hope that the book will help women and those who care for them.

After an introductory section which describes the issues and the background (which means you don’t need any prior knowledge in order to make sense of it), I look at the different kinds of screening that are used in different areas of the Western world:

“Two very different approaches to screening emerged, and both of them remain quite crude. A good screening test will identify as many of the people who have a particular problem as possible, while not identifying too many people as being at risk if they don’t have the problem. These elements are referred to as sensitivity and specificity. Both of the current approaches to screening for GBS disease are reasonably good (although not perfect) at picking up most of the people who are at risk (that is, they are quite sensitive) but both pick up very high numbers of people who are not at risk (so they are not very specific). Given that the consequence of being defined as ‘at risk’ is to be offered antibiotics in labour – which, if you decide to have them, means having a cannula in your arm and (usually) being in hospital, and having antibiotics that have their own associated risks – this is by no means an ideal situation.” (Wickham 2014)

I have also detailed which women are perceived to be at risk within the UK, and looked at who will be offered antibiotics in labour, and who won’t.  Throughout the book, I have taken into account that not all women will want to follow the guidance, for lots of different reasons, and have addressed questions around how to decline screening and treatment that you do not want as well as how to get screening and treatment if you do want this but it is not on offer locally.  I have also looked at the evidence that exists in relation to different elements of this debate because, as we know, research findings are open to interpretation and there is not always a perfect correlation between evidence and guidelines (sometimes for good reason).

In other parts of the book, I look at the different kinds of testing that are used, and consider which is more accurate.  I discuss the pros, cons, implications, side effects and reality of having antibiotics, and of how having screening and/or treatment for GBS can affect other birth-related decisions; something that I don’t think people always realise.  I have, before anyone asks, gathered together what I can find on GBS and waterbirth and looked at alternatives to antibiotics (though there really isn’t much evidence, and we need much more research into this). I’ve included a whole section on FAQs so that women who are in a hurry can turn to that section and find a shorter answer rather than having to read the whole book again.  And, knowing that not every woman wants GBS screening and treatment, I have looked at ongoing options once the baby is born, including signs of infection in babies – or, what to look for if you decline treatment.

“There are no rights and wrongs here. The important thing is to weigh up the information, consider your own circumstances, beliefs and feelings and to make the best decision that you can for your own personal situation.” (Wickham 2014).

I really hope this book will help women and their families, as well as those caring for women who want an update on the evidence / issues.  There is so little out there on this, and many women have expressed a need to AIMS for such a book.  The AIMS committee and several other people have worked really hard on this with me – thank you all – and I am delighted that quite a few of them will be with me at the launch event for the book, which will take place in Bristol on the evening of Wednesday 26th November, so if you’re coming to that, I’ll see you there!

 

4 comments for “Group B Strep Explained

  1. Vicky
    November 20, 2014 at 10:19 am

    I had a lovely consultant who said there was no reason not to have a water birth even with a canula, just to keep that arm out of the pool. Didn’t happen in the end as birthing pool was in use, but was good to still feel that my options were open.

    • November 20, 2014 at 10:21 am

      It’s also possible to protect women’s hands with a glove (like the midwives wear) and some tape or bandage to keep the cannula dry 🙂

  2. Tania
    August 11, 2015 at 11:01 am

    Sara, although I missed your presentation on this topic during your recent trip out to Australia, I am glad I purchased the GBS Explained book!! As a midwife & now consumer of maternity services, I found this text quite engaging. As a midwife you are provided with some foundation knowledge but no always do we have time to sift through the research & literature as you have kindly done here. While some information was obvious, it was interesting to hear of the various techniques available & of the case where the woman had 2 babies with GBS disease & was noted to have low serum antibodies to GBS.

    What are your thoughts on the use of serology screening as a method of determining women who may potentially be ‘at risk’ for passing on GBS to their unborn babies? Do you believe there is some benefit in this over swabbing? Further to this; how does the new concept of vaginal swabbing in women having elective LUSCS fair in the GBS debate if women are still electing to have testing?

    Tania

  3. Jasmine
    March 2, 2016 at 11:48 am

    Dear Sara,

    I have just ordered and read your superb book on GBS, which has been the best account and summary of current practice I have found.

    I was wondering whether you could clarify a couple of points. Firstly, what (if any) are the signs of a GBS infection in a pregnant woman? It is typically described as asymptomatic, however many women who have UTIs (for example persistent thrush that isn’t solved using traditional creams and pessaries) are encouraged to test for GBS, thus does this anecdotally suggest a link? You mention this subject on pages 34 and 35 of your book, but I was wondering if you might extrapolate further… If persistent UTIs are not sometimes a sign of GBS infection in pregnancy, what are?

    Those I have come across that argue for GBS testing due to persistent UTIs also seem to maintain that they believe the UTI, and therefore possibly the GBS, is a symptom of a lowered immune system. In your view, is it possible for GBS bacteria to manifest in an aggressive way and undermine immunity during pregnancy and not at any other time?

    Very many thanks for all of your work and brilliant dedication to difficult subjects in pregnancy. They are very much appreciated.

    Jasmine

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